Journal of Rehabilitation Research & Development (JRRD)

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Volume 49 Number 5, 2012
   Pages 703 — 716

Abstract — Pharmacotherapy for posttraumatic stress disorder: Review with clinical applications

Matthew Jeffreys, MD;1* Bruce Capehart, MD, MBA;2 Matthew J. Friedman, MD, PhD3
1South Texas Veterans Health Care System, San Antonio, TX; and University of Texas Health Science Center, San Antonio, TX; 2Durham Department of Veterans Affairs Medical Center (VAMC), Durham, NC; and Duke University, Durham, NC; 3National Center for PTSD, White River Junction, VT; White River Junction VAMC, White River Junction, VT; and Dartmouth Medical School, Hanover, NH

Abstract–Posttraumatic stress disorder (PTSD) is a prevalent psychiatric diagnosis among veterans and has high comorbidity with other medical and psychiatric conditions. This article reviews the pharmacotherapy recommendations from the 2010 revised Department of Veterans Affairs/Department of Defense Clinical Practice Guideline (CPG) for PTSD and provides practical PTSD treatment recommendations for clinicians. While evidence-based, trauma-focused psychotherapy is the preferred treatment for PTSD, pharmacotherapy is also an important treatment option. First-line pharmacotherapy agents include selective serotonin reuptake inhibitors and the selective serotonin-norepinephrine reuptake inhibitor venlafaxine. Second-line agents have less evidence for their usefulness in PTSD and carry a potentially greater side effect burden. They include nefazodone, mirtazapine, tricyclic antidepressants, and monoamine oxidase inhibitors. Prazosin is beneficial for nightmares. Benzodiazepines and antipsychotics, either as monotherapy or used adjunctively, are not recommended in the treatment of PTSD. Treating co-occurring disorders, such as major depressive disorder, substance use disorders, and traumatic brain injury, is essential in maximizing treatment outcomes in PTSD. The CPG provides evidence-based treatment recommendations for treating PTSD with and without such co-occurring disorders.

Key words: best practices, guidelines, health services, medications, mental health, patient care, pharmacotherapy, PTSD, treatment, veterans.


View HTML  ¦  View PDF  ¦  Contents Vol. 49, No. 5
This article and any supplementary material should be cited as follows:
Jeffreys M, Capehart B, Friedman MJ. Pharmacotherapy for posttraumatic stress disorder: Review with clinical applications. J Rehabil Res Dev. 2012;49(5):703–16.
http://dx.doi.org/10.1682/JRRD.2011.09.0183
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Last Reviewed or Updated  Wednesday, July 18, 2012 9:31 AM

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